Health Systems Strengthening Innovations In Policy, Processes and Technology- Bhudeb Chakravarti, National Institute for Smart

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  • 1. Need for Process Reengineering in Healthcare Bhudeb Chakravarti Senior General Manager & Region Head National Institute for Smart Government
  • 2.
    • Long Queues at OPD
    • Air of Mystification about status of patient
    • There is no need assessment of requirement of “Admission to Hospital” or “Days of Stay”
    • Multiple Visits to Hospitals for same treatment
        • Sometimes to other hospitals (so called Multi-Speciality Hospitals)
    • Outcome is in Suspense (Either time of cure or chance of cure)
    • Poor Quality of Service (Most of the time it is next to impossible to measure the Quality)
    • Doctor is the Final Decision Maker
    Symptoms of Poor Healthcare Processes
  • 3. Symptoms of In-Efficient HIS
    • Extensive Information Exchange & Multiple Entry of Data (Some data not verified)
    • Doctors now suffer from the “information paradox”, drowning in information but cannot find the information they need
    • Patient information is often neither evidence based nor easily accessible
    • No EMR  No way of accessing Critical Care Data
    • Too many Controls and Checks
    • 60% of Clinician time is spent searching or waiting for patient information
    • Exception is the Rule
  • 4. Value to Patient
    • The core issue in Healthcare is the value of healthcare delivered
    • The extent of medical errors is largely unknown
      • Unnecessary deaths are attributed to medication related errors, unneeded or ineptly performed surgeries
      • Heavy reliance on paper based patient records in medical institutions
      • Untimely or mistaken diagnoses
      • Repeat of the data collection process (in the process missing some vital test results)
      • Old factors are often missed as data not available
  • 5. Recommended Steps
    • Streamline Key Processes through Business Process Re-engineering (BPR)
    • Capture Information at Source
    • Identify Key Performance Indicators and Evaluate the Performance Accordingly
    • Simplify Reporting Formats
    • Single Integrated Collection of Data (No Multiple Registers)
    • Track and Monitor Each Process on Regular basis
    • All the information available to professional should be available to patients
  • 6. Definition of BPR
    • Business Process Reengineering is
        • “ the fundamental rethinking and redesign of business processes to achieve dramatic improvements in critical contemporary measures of performance such as cost, quality, service and speed.”
            • - Hammer and Champy
  • 7. Basic Principles of BPR
    • Organize around outcomes, not tasks
    • Identify all the processes in an organization and prioritize them in order of redesign urgency
    • Integrate information processing work into the real work that produces the information
    • Treat geographically dispersed resources as though they were centralized
    • Link parallel activities in the workflow instead of just integrating their results
    • Put the decision point where the work is performed, and build control into the process
    • Capture information once and at the source
  • 8. Key Process Parameters Safety and Quality Effective and Evidence Based Patient Centered: Patient Values Guide Devisions Timely: Reduced Waiting Times and Delays Efficient: Avoid Wastes Equitable: Care doesn’t vary by Gender, Class or Status
  • 9. Transformation of Healthcare Professionals as Authorities  Professionals as Partners  Professionals as Facilitators Self Help Networks Friends and Family Individual Self Care Reduced Cost, Increased Value
  • 10. Collaboration & Standardisation Investigation Labs Pharmacies Employer Equipment Suppliers PATIENT Insurance Providers Healthcare Providers
  • 11. NKC Recommendations
    • Initiate development of Indian Health Information Network
    • Establish national standards for clinical terminology and health informatics
    • Create a common electronic health record (EHR)
    • Frame policies to promote use of IT in health care
    • Create appropriate policy framework to protect health data of citizens
    • Medical Informatics to be part of medical and paramedical curriculum
    • Create an institution framework for implementation
  • 12. Recommended Functionalities
    • Wide Area Health Network
    • EMR including Physician Order Entry System (e-Prescriptions and e-Referral)
    • Reduction of waiting Times between when Lab Results are requested and when they are delivered through the utilisation of faster communication technologies such as email.
    • Reconfigure laboratories so that they can perform the most frequently requested tests faster
    • Share critical patients between Hospitals so that both facilities have similar capacity levels. This is more efficient than taking on patients until capacity is reached
    • Synchronise the physical and virtual parts of processes
    • Clinical Decision Support systems (CDS) must be carefully designed so that they are reliable and accurate
  • 13. Conclusion
    • Knowing is not enough;
    • we must apply.
    • Willing is not enough;
    • we must do.
    • - Johann Wolfgang von Goethe
  • 14. Any Queries [email_address]